XXX INTERNATIONAL MEETING FACULTY ON-LINE REGISTRATION FORM

PERSONAL DATA

TITLE   --------PROF.DR.MR/MS/MRS

NAME  

MIDDLE NAME If applicable.

SURNAME  

E-MAIL  

MOBILE PHONE No.  

PLEASE INDICATE THE NAME OF YOUR SECRETARY/ASSISTANT FOR CONTACTS

PLEASE INDICATE THE E-MAIL ADDRESS OF YOUR SECRETARY/ASSISTANT

MANDATORY DATA TO BE STATED IN THE BOOKLET

PLEASE INDICATE YOUR POSITION:  

PLEASE INDICATE YOUR ORGANIZATION/COMPANY:  

PLEASE INDICATE YOUR DEPARTMENT/DIVISION/UNIT  

PLEASE INDICATE THE TITLE OF YOUR PRESENTATION  

HOTEL ACCOMMODATION

HOTEL BOOKING   -----------------------------------------------------------YES, PLEASE BOOK MY ROOM AS FOLLOW:NO, I DO NOT NEED ANY ACCOMMODATION

PLEASE SELECT THE NIGHT/S

NOVEMBER 30

DECEMBER 1

I REQUIRE ADJUNCTIVE NIGHT/S

PLEASE INDICATE THE ADJUNCTIVE NIGHT/S IF REQUIRED PLEASE NOTE, THE CONFERENCE ORGANIZATION WILL COVER THE EXPENSES FOR A MAXIMUM OF 2 NIGHTS, EXTRA NIGHTS COULD BE BOOKED BUT SHALL BE CONSIDERED IN CHARGE OF THE PARTICIPANT AND SHALL BE PAID DIRECTLY TO THE HOTEL UPON DEPARTURE.

TYPE OF ROOM

DOUBLE ROOM SINGLE USE (DUS)

DOUBLE

TWIN (2 separate beds)

NAME AND SURNAME OF THE ACCOMPANYING PERSON

PLEASE INDICATE IF YOU NEED A CAR PARKING PLACE IN THE PRIVATE HOTEL PARKING

YES
NO

DINNERS

PLEASE PROVIDE US FOR YOUR KIND CONFIRMATION.

I CONFIRM I WILL ATTEND THE FOLLOWING DINNER/S:  

SUNDAY NOVEMBER 30 (WELCOME BUFFET DINNER AT THE HOTEL-FACULTY MEMBERS AND DELEGATES)

MONDAY DECEMBER 1 (SOCIAL DINNER AT THE HOTEL-FACULTY MEMBERS AND DELEGATES)

I WILL NOT ATTEND ANY DINNER

PLEASE INDICATE ANY DIETARY RESTRICTIONS OR ALLERGIES

TRAVEL

TRAVEL EXPENSES ARE TO BE COVERED BY YOUR COMPANY. AIRPORT TRANSFERS WILL BE ARRANGED BY THE SECRETARIAT. AN OFFICIAL AFFILIATED TAXI SERVICE IS AVAILABLE FROM SANTA MARIA NOVELLA TRAIN STATION.

PLEASE INDICATE THE MEANS OF TRANSPORTATION YOU WILL USE FOR YOUR TRAVEL  

FLIGHT

TRAIN

CAR

PLEASE PROVIDE US FOR THE FOLLOWING INFORMATION:

PLEASE INDICATE THE DEPARTURE DATE AND THE TIME OF THE ARRIVAL FLIGHT/TRAIN

Anno --2025 / Mese --gennaiofebbraiomarzoaprilemaggiogiugnoluglioagostosettembreottobrenovembredicembre / Giorno --12345678910111213141516171819202122232425262728293031   Ora --000102030405060708091011121314151617181920212223 : Minuto --000510152025303540455055

PLEASE INDICATE THE DEPARTURE DATE AND THE TIME OF THE RETURN FLIGHT/TRAIN

Anno --2025 / Mese --gennaiofebbraiomarzoaprilemaggiogiugnoluglioagostosettembreottobrenovembredicembre / Giorno --12345678910111213141516171819202122232425262728293031   Ora --000102030405060708091011121314151617181920212223 : Minuto --000510152025303540455055

IN ORDER TO GUARANTEE THE CORRECT ASSISTANCE, PLEASE UPLOAD THE COPY OF THE TICKETS OR THE ITINERARY MANDATORY FOR THE TRANSFER ARRANGEMENTS FORM/TO THE AIRPORT